This clinical update with Dr. Daniel Griffin covers a range of pressing infectious disease topics, framed by an initial discussion on the dangerous real-world consequences of anti-science rhetoric, specifically the recent violent attack on the CDC. The episode provides updates on public health outbreaks, including Vibrio vulnificus in warming coastal waters and a deadly Legionnaire's disease outbreak in Harlem. A significant portion is dedicated to vaccine policy, detailing the American Academy of Pediatrics' decision to release its own immunization schedule, which differs from the CDC's on key recommendations for RSV, influenza, and COVID-19 in children. Dr. Griffin also discusses the benefits of high-dose flu vaccines for older adults and the small but noted risk of Guillain-Barré syndrome with certain RSV vaccines. Surveillance data shows a continued surge in measles cases in the US and globally, record pediatric flu deaths from the past season, and rising COVID-19 wastewater signals. Finally, new research is highlighted, including a study on Ivermectin's potential to control malaria and a concerning finding from the CARTESIAN study on accelerated vascular aging (artery stiffening) after COVID-19 infection, particularly in women.
TWiV 1246: Clinical Updates on Respiratory Viruses, Vaccines, and Public Health Threats
0:00 Consequences of Anti-Science Rhetoric: The episode opens by discussing the violent attack on the CDC, linking it directly to anti-vaccine sentiment and highlighting the dangerous, real-world consequences of targeted disinformation campaigns against public health institutions and workers.
8:07 Vibrio vulnificus Alert: The Massachusetts Department of Public Health has issued an alert for rare but dangerous Vibrio vulnificus bacteria in coastal waters. Rising water temperatures create favorable conditions for the bacteria, which can cause life-threatening sepsis, especially in individuals with open wounds or compromised liver function.
10:37 Ivermectin for Malaria Control: A new study in the New England Journal of Medicine shows that mass administration of Ivermectin reduced malaria incidence by 26% compared to a control group. The drug likely works as both an insecticide against mosquitoes (which feed on treated individuals) and as an antiparasitic targeting the malaria parasite's life cycle.
14:31 Legionnaire's Disease Outbreak in Harlem: An ongoing outbreak in Harlem has resulted in 111 confirmed cases and six deaths. Dr. Griffin discusses the history of the disease, its transmission via contaminated water sources like cooling towers, and the importance of proper diagnosis and testing.
20:28 AAP's Independent Vaccine Schedule: The American Academy of Pediatrics (AAP) has released its own evidence-based immunization schedule, which differs from the CDC's. This move is a response to concerns that the CDC's advisory committee has been compromised by individuals who spread vaccine misinformation.
21:49 AAP RSV & Flu Recommendations for Children: The AAP strongly recommends RSV immunization for infants under 8 months and annual flu vaccines for all children over 6 months. Dr. Griffin emphasizes the severity of influenza, noting that 270 children died from it last season, the majority of whom were unvaccinated and otherwise healthy.
24:18 AAP COVID-19 Vaccine Guidance for Children: The AAP recommends COVID-19 vaccines for all children aged 6-23 months, as their risk is comparable to adults over 65. For children aged 2-18, it is recommended for high-risk groups and made available to any child whose parents desire protection.
25:58 Alarming Measles Surge: Measles cases in the U.S. have climbed to 1,375 across 42 jurisdictions. Globally, the Pan American Health Organization reports a 34-fold increase in cases across the Americas compared to the previous year, with Canada, Mexico, and the U.S. having the highest numbers.
29:41 High-Dose Flu Vaccine Benefits for Seniors: For adults 65 and older, data shows that high-dose influenza vaccines are significantly more effective than standard-dose vaccines. They are associated with a 63-67% reduction in hospitalizations and a 74% reduction in all-cause mortality.
33:02 RSV Vaccine and Guillain-Barré Syndrome (GBS) Risk: The current recommendation for the RSV vaccine is a one-time dose for adults 75 and older (or 50-74 with risk factors). A small risk of GBS, estimated at 7-9 excess cases per million vaccinations, has been associated with the GSK and Pfizer vaccines in clinical trials, though no cases were reported with the Moderna mRNA vaccine.
36:19 Long COVID Linked to Accelerated Vascular Aging: A major multinational study (CARTESIAN) reveals that COVID-19 infection is associated with accelerated vascular aging, measured by artery stiffening. This effect was observed even in non-hospitalized individuals and was predominantly seen in women.
41:29 Challenges in Public Health Access: The episode concludes with listener feedback highlighting difficulties in tracking official measles data (with Johns Hopkins and Brown University trackers suggested as alternatives) and major barriers to accessing timely COVID-19 treatments like Paxlovid due to high costs.